Inhaled Nitric Oxide/INOpulse DS for Pulmonary Arterial Hypertension (PAH)

NCT ID: NCT01457781

Last Updated: 2023-02-27

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE2

Total Enrollment

80 participants

Study Classification

INTERVENTIONAL

Study Start Date

2012-04-30

Study Completion Date

2016-07-31

Brief Summary

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This is a Phase 2, Placebo Controlled, Double-Blind, Randomized, Clinical Study to Determine Safety, Tolerability and Efficacy of Pulsed, Inhaled Nitric Oxide (iNO) Versus Placebo as Add-on Therapy in Symptomatic Subjects with Pulmonary Arterial Hypertension (PAH).

Detailed Description

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Study to determine if inhaled nitric oxide (iNO) given through a special delivery device (INOpulse® DS) is safe and efficacious in treating Pulmonary Arterial Hypertension (PAH). Medical literature and clinical experience suggests that iNO at pulsed doses of 0.013 to 0.1 mg/kg per hour for 1 month to 2+ years appears safe and suggests efficacy for the treatment of pulmonary hypertension.

There are two parts to this study. In Part 1 (week 0 to week 16), the objectives are to determine the safety, tolerability, efficacy, and exploratory objectives of two different doses of iNO delivered by a pulsed delivery device in symptomatic subjects with PAH who remain symptomatic due to PAH on approved PAH monotherapy or combination approved PAH therapy. In Part 2 (week 17 to end of study Part 2 \[EOS Part 2\]), the objective is to compile data on the long-term effects of iNO on safety, tolerability, clinical and hemodynamic measures.

Conditions

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Pulmonary Arterial Hypertension Pulmonary Hypertension

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

CROSSOVER

Primary Study Purpose

TREATMENT

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors

Study Groups

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0.025 mg inhaled nitric oxide

Inhaled nitric oxide (iNO) 0.025 mg/kg IBW/hr for up to 24 hours/day x 16 weeks (3.0 mg/L \[2440 ppm\] NO mini-cylinder; change q 24 hours) delivered via INOpulse® DS delivery device.

Group Type ACTIVE_COMPARATOR

Inhaled Nitric Oxide 0.025 mg/kg IBW/hr delivered via INOpulse DS Device

Intervention Type COMBINATION_PRODUCT

Cohort 1: 0.025 mg/kg IBW/hr for up to 24 hours/day x 16 weeks (3.0 mg/L \[2440 ppm\] NO mini-cylinder; change q 24 hours) delivered via INOpulse DS Device and INOpulse DS nasal cannula

0.075 mg inhaled nitric oxide

Inhaled nitric oxide (iNO) 0.075 mg/kg IBW/hr for up to 24 hours/day x 16 weeks (6.0 mg/L \[4880 ppm\] NO mini-cylinder; change q 24 hours) delivered via INOpulse® DS delivery device.

Group Type ACTIVE_COMPARATOR

Inhaled nitric oxide 0.075 mg/kg IBW/hr delivered via INOpulse DS Device

Intervention Type COMBINATION_PRODUCT

Cohort 2: 0.075 mg/kg IBW/hr for up to 24 hours/day x 16 weeks (6.0 mg/L \[4880 ppm\] NO mini-cylinder; change q 24 hours) delivered via INOpulse DS Device and INOpulse DS nasal cannula

placebo

Placebo 0.075 mg/kg IBW/hr for up to 24 hours/day x 16 weeks\* (99.999% Nitrogen \[N2\] mini-cylinder; change q 24 hours) delivered via INOpulse® DS delivery device.

Group Type PLACEBO_COMPARATOR

Placebo delivered via INOpulse DS Device

Intervention Type COMBINATION_PRODUCT

Placebo 0.075 mg/kg IBW/hr for up to 24 hours/day x 16 weeks (Nitrogen N2, 99.999%) delivered via INOpulse DS Device and INOpulse DS nasal cannula

Interventions

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Inhaled Nitric Oxide 0.025 mg/kg IBW/hr delivered via INOpulse DS Device

Cohort 1: 0.025 mg/kg IBW/hr for up to 24 hours/day x 16 weeks (3.0 mg/L \[2440 ppm\] NO mini-cylinder; change q 24 hours) delivered via INOpulse DS Device and INOpulse DS nasal cannula

Intervention Type COMBINATION_PRODUCT

Placebo delivered via INOpulse DS Device

Placebo 0.075 mg/kg IBW/hr for up to 24 hours/day x 16 weeks (Nitrogen N2, 99.999%) delivered via INOpulse DS Device and INOpulse DS nasal cannula

Intervention Type COMBINATION_PRODUCT

Inhaled nitric oxide 0.075 mg/kg IBW/hr delivered via INOpulse DS Device

Cohort 2: 0.075 mg/kg IBW/hr for up to 24 hours/day x 16 weeks (6.0 mg/L \[4880 ppm\] NO mini-cylinder; change q 24 hours) delivered via INOpulse DS Device and INOpulse DS nasal cannula

Intervention Type COMBINATION_PRODUCT

Eligibility Criteria

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Inclusion Criteria

1. Signed informed consent form (ICF) (and assent as appropriate) prior to the initiation of any study mandated procedures or assessments
2. A confirmed diagnosis of Pulmonary Hypertension Group 1 (PAH) who have either idiopathic PAH (IPAH), heritable PAH, anorexigen-induced PAH, associated PAH (APAH) with connective tissue disease (CTD), APAH with repaired simple congenital systemic to pulmonary shunt (i.e., atrial septal defect \[ASD\], ventricular septal defect \[VSD\] and/or patent ductus arteriosus \[PDA\]; complete repair at least 1 year prior to Screening) or APAH with human immunodeficiency virus (HIV)
3. Confirmation of PAH diagnosis at the time of Baseline RHC according to the following definition: mPAP ≥ 25 mmHg at rest, with a concomitant mean pulmonary capillary wedge pressure (mPCWP), mean left atrial pressure (mLAP), or left ventricular end diastolic pressure (LVEDP) ≤ 15 mmHg and a PVR ≥ 240 dynes.sec/cm-5
4. 6MWD at least 100 meters and no greater than 450 meters
5. The subject is receiving at least one approved PAH therapy and is clinically symptomatic from PAH (e.g., onset or increased dyspnea on exertion, dizziness, near-syncope, syncope, chest pain or peripheral edema)
6. Background PAH medication doses (including calcium channel blockade if being used to treat PAH) must be stable for at least 12 weeks prior to Screening
7. If on background conventional therapy (e.g., digoxin, diuretics, supplemental oxygen, anticoagulation), it must have been started at least 30 days prior to Screening and be on a stable dose for at least 30 days except for anticoagulation dose
10. Age between 16 and 80 years (inclusive)
11. Male height ≤ 200 cm (6'7") or Female height ≤ 210 cm (6'11")
12. Subjects are willing and considered in the judgment of the Investigator able to use the INOpulse DS device continuously for up to 24 hours per day
13. Females of childbearing potential must have a negative pre-treatment serum pregnancy test and must be on a reliable method of contraception (including double protection if appropriate, e.g., for subjects concurrently treated with bosentan therapy)

4. PAH associated with significant venous or capillary involvement (PCWP \> 15 mmHg), known pulmonary veno-occlusive disease, or pulmonary capillary hemangiomatosis
5. Any subject with WHO PH Groups 2, 3, 4 or 5
6. Left ventricular systolic dysfunction, i.e., left ventricular ejection fraction (LVEF) \< 40% or left ventricular shortening fraction (LVSF) \< 22%
7. Left ventricular diastolic dysfunction, i.e., PCWP \> 15 mmHg at rest or with exercise, acute volume loading or pharmacologic testing
8. History of clinically significant cardiomyopathy or valvular heart disease (i.e., moderate or greater aortic insufficiency; moderate or greater aortic stenosis; or moderate or greater mitral valve disease)
9. Clinically significant cardiac ischemic disease requiring use of nitrates, or hospital admission for acute coronary syndrome or intervention (percutaneous coronary intervention, coronary artery stent, coronary artery bypass surgery) within the past 90 days
10. Down syndrome
11. Any subject who develops a PCWP \> 20 mmHg during AVT with iNO
12. Systemic hypertension defined as systolic blood pressure (SBP) \> 160 mmHg and/or diastolic blood pressure (DBP) \> 100 mmHg persistent at Screening after a period of rest (treated or untreated)
13. Systemic hypotension defined as SBP \< 90 mmHg persistent at Screening after a period of rest
14. Moderate to severe obstructive lung disease defined as both a forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) \< 70% and FEV1 \< 65% of predicted value (bronchodilator administration prior to testing is optional; the test should be done within 3 years for all subjects with the exception of APAH/CTD which needs to be done within 6 months prior to Screening)
15. Moderate to severe restrictive lung disease: total lung capacity (TLC) \< 60% of predicted; if TLC 60% to 70% predicted, a high resolution CT scan showing diffuse disease or more than mild patchy disease (done within 3 years for all subjects with the exception of APAH/CTD which needs to be done within 6 months prior to Screening)
16. Moderate to severe hepatic impairment, i.e., Child-Pugh Class B or C
17. Estimated creatinine clearance \< 30 mL/min (Cockcroft-Gault formula)
18. Hemoglobin \< 10 gm/dL at Screening or Baseline
19. Acute or chronic physical impairment (other than dyspnea due to PAH) that would limit the ability to comply with study procedures or adherence to therapy, including carrying and wearing the INOpulse device per study protocol
20. Pregnant or breast-feeding at Screening
21. Administered L-arginine within 30 days prior to Screening
22. Known concomitant life-threatening disease with a life expectancy less than 1 year
23. Recently started (\< 12 weeks prior to randomization) or planned cardiopulmonary rehabilitation program to start within the 16 week controlled study
24. Atrial septostomy within 3 months of randomization
25. Any subject with PAH who is treatment naïve or receiving any unapproved therapy as their only PAH treatment (including calcium channel blockade if the calcium channel blockade is the only treatment for the PAH)
26. Any subject who requires the use of a continuous positive airway pressure (CPAP), bilevel positive airway pressure (BiPAP), or other positive pressure devices to treat obstructive sleep apnea
27. Medical problem(s) likely to preclude completion of Part 1
28. Use of investigational drugs or devices within 30 days prior to enrollment into the study (other than acute vasodilator testing with iNO or IV epoprostenol)
29. Any underlying medical or psychiatric condition that, in the opinion of the Investigator, makes the subject an unsuitable candidate for the study
30. Any condition other than the subject's PAH that, in that opinion of the investigator, affects their ability to perform the 6MWT
31. Refusal to follow the protocol, including the two RHCs in Part 1 and one RHC in Part 2
32. Unable to travel to the investigational site for all required study visits and for all additional visits per the judgment of the Investigator or Sponsor

Exclusion Criteria

1. Subjects with known HIV infection within the past 2 years who have a history of or show any clinical or laboratory evidence of any opportunistic pulmonary disease (e.g., tuberculosis, Pneumocystis carinii pneumonia, or other pneumonias) at the time of Screening
2. PAH associated with portal hypertension, untreated thyroid disorders, glycogen storage disease, Gaucher's disease, hereditary hemorrhagic telangiectasia, hemoglobinopathies, myeloproliferative disorders or splenectomy
Minimum Eligible Age

16 Years

Maximum Eligible Age

80 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Bellerophon Pulse Technologies

INDUSTRY

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Ashika Ahmed, MD

Role: STUDY_DIRECTOR

Bellerophon Therapeutics

Locations

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University of Alabama at Birmingham

Birmingham, Alabama, United States

Site Status

Arizona Pulmonary Specialists

Phoenix, Arizona, United States

Site Status

Allianz Research Institute, Inc.

Fountain Valley, California, United States

Site Status

University of California, San Francisco-Fresno

Fresno, California, United States

Site Status

West Los Angeles VA Healthcare Center

Los Angeles, California, United States

Site Status

David Geffen School of Medicine at UCLA

Los Angeles, California, United States

Site Status

Los Angeles Biomedical Research Institute at Harbor-UCLA Med Ctr

Torrance, California, United States

Site Status

Children's Hospital Colorado

Aurora, Colorado, United States

Site Status

University of Colorado Denver

Aurora, Colorado, United States

Site Status

South Denver Cardiology Associates P.C.

Littleton, Colorado, United States

Site Status

Christiana Care Health System

Newark, Delaware, United States

Site Status

University of Florida College of Medicine

Jacksonville, Florida, United States

Site Status

Cleveland Clinic Florida

Weston, Florida, United States

Site Status

Emory University Hospital-Emory Clinic

Atlanta, Georgia, United States

Site Status

University of Iowa Hospitals & Clinics

Iowa City, Iowa, United States

Site Status

University of Kansas Medical Center

Kansas City, Kansas, United States

Site Status

University of Kentucky Gill Heart

Lexington, Kentucky, United States

Site Status

Kentuckiana Pulmonary Associates

Louisville, Kentucky, United States

Site Status

LSUHSC-New Orleans

New Orleans, Louisiana, United States

Site Status

University of Maryland Medical Center

Baltimore, Maryland, United States

Site Status

Tufts Medical Center

Boston, Massachusetts, United States

Site Status

Boston University Medical Center/Boston University School of Medicine

Boston, Massachusetts, United States

Site Status

University of Michigan

Ann Arbor, Michigan, United States

Site Status

University of Minnesota, Cardiovascular Division

Minneapolis, Minnesota, United States

Site Status

Mayo Clinic

Rochester, Minnesota, United States

Site Status

Washington University School of Medicine

St Louis, Missouri, United States

Site Status

Dartmouth-Hitchcock Medical Center

Lebanon, New Hampshire, United States

Site Status

University of Medicine and Dentistry of NJ

Newark, New Jersey, United States

Site Status

Barnabas Health Newark Beth Israel Medical Center

Newark, New Jersey, United States

Site Status

Beth Israel Medical Center

New York, New York, United States

Site Status

Weill Cornell Medical Center

New York, New York, United States

Site Status

Montefiore Medical Center

The Bronx, New York, United States

Site Status

Duke University Medical Center

Durham, North Carolina, United States

Site Status

UC Health/University of Cincinnati

Cincinnati, Ohio, United States

Site Status

University Hospitals Case Medical Center

Cleveland, Ohio, United States

Site Status

Cleveland Clinic

Cleveland, Ohio, United States

Site Status

Ohio State University Martha Morehouse Medical Pavillion

Columbus, Ohio, United States

Site Status

South Oklahoma Heart Research LLC

Oklahoma City, Oklahoma, United States

Site Status

Legacy Medical Group - Pulmonary Clinic

Portland, Oregon, United States

Site Status

Temple University Hospital

Philadelphia, Pennsylvania, United States

Site Status

Allegheny Singer Research Institute/Allegheny General Hospital

Pittsburgh, Pennsylvania, United States

Site Status

Rhode Island Hospital

Providence, Rhode Island, United States

Site Status

Sioux Falls Cardiovascular PC

Sioux Falls, South Dakota, United States

Site Status

University of Texas Southwestern Medical Center

Dallas, Texas, United States

Site Status

Baylor College of Medicine

Houston, Texas, United States

Site Status

Intermountain Medical Center

Murray, Utah, United States

Site Status

Aurora St. Luke's Medical Center

Milwaukee, Wisconsin, United States

Site Status

Peter Lougheed Center

Calgary, Alberta, Canada

Site Status

ABACUS - University of Alberta Hospitals

Edmonton, Alberta, Canada

Site Status

London Health Sciences Centre

London, Ontario, Canada

Site Status

University Health Network - Toronto General Hospital

Toronto, Ontario, Canada

Site Status

Countries

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United States Canada

Other Identifiers

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IK-7001-PAH-201

Identifier Type: -

Identifier Source: org_study_id

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